Kounis-syndrome I24.9

Kounis syndrome is defined as a rare allergic acute coronary syndrome (ACS) caused by a strong immune reaction triggered by drugs (e.g. ceftriaxone, pethidine), environmental factors such as insect bites (Ralapanawa DM et al. 2014), food or implanted coronary stents. Coronary symptomatology is usually associated with further anaphylactic or anaphylactoid reactions (Abdelghany M et al. 2017).

Kounis syndrome does not appear to be a rare disease, merely one that is rarely diagnosed clinically (Kounis NG et al. 1991).

Pathologically-anatomically, the following processes may underlie the syndrome:

• vasospastic allergic angina pectoris
• an allergic myocardial infarction
• a stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells.

In the latter, nickel allergy seems to be a leading problem, but also possible allergies to other components such as the drug coating in DEStents. Besides coronary arteries, cerebral and mesenteric arteries may also be affected.

Signs of acute coronary syndrome with acute chest pain and shortness of breath with and without ST-segment elevation (NSTEMi/STEMI)

Kounis syndrome should be distinguished from the far more common (non-allergic) Prinzmetal's angina and the very rare eosinophilic coronary periarteritis, which is characterized by extensive eosinophilic infiltration of the adventitia and periadventitia of the coronary arteries.

1. Abdelghany M et al. (2017) Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. Int J Cardiol 232:1-4.

2. Kounis NG et al (1991) Histamine-induced coronary artery spasm: the concept of allergic angina. The British Journal of Clinical Practice 45: 121-128.

3. Ralapanawa DM et al (2014) A case of Kounis syndrome after a hornet sting and literature review. BMC Res Notes 7:867.

4. Saleh AA (2014) Kounis syndrome: Acute inferior myocardial infarction with atroventriculae node block due to ceftriaxone: a first reported case. Ann of Saudi Med 34: 250-253